The switch from tenofovir disoproxil fumarate to tenofovir alafenamide determines weight gain in patients on rilpivirine-based regimen

OBJECTIVE: To investigate whether the switch from tenofovir disoproxil fumarate/emtricitabine/rilpivirine (TDF/FTC/RPV) to tenofovir alafenamide (TAF)/FTC/RPV is associated with weight gain in people living with HIV (PLWHIV). DESIGN: Retrospective single-centre study. METHODS: All PLWHIV on TDF/FTC/RPV who switched to TAF/FTC/RPV from January 2017 to December 2018 were considered if they had at least two weight measures in the year before and two after the switch. The weight trend across the study was evaluated by a generalized linear model for repeated measures, with pair comparison performed by Bonferroni adjustment. RESULTS: Two hundred and fifty-two patients on TDF/FTC/RPV were included, 65% men, mean age 51.2 years (\ub19.6), history of 18 (\ub118.2) years of HIV infection and CD4 T-cell count of 744 (\ub1329) cells/\u3bcl. All had HIV-RNA <50\u200acopies/ml. Twelve months before the switch, baseline weight was 73.8 (\ub114.3) kg, and remained stable to 73.8 (\ub114.3) kg in the following 6 months. A weight increase was noticed 3 and 6 months after the switch, to 77.7 (\ub142.3) and 75.5 (\ub114.5) kg, respectively (P\u200a<\u200a0.0001). A significant weight change exactly within the timeframe of the switch (between 6 months before and 3 months after) was found in women, patients with higher BMI (>25\u200akg/m), lower CD4 T-cell count ( 64500\u200acells/\u3bcl) and history of previous drug abuse. The frequency of BMI greater than 25\u200akg/m rose from 122/252 patients (48.4%), to 133/252 (52.8%) (P\u200a<\u200a0.0001). CONCLUSION: TAF appears to have an impact on weight gain, similarly to what observed in na\uefve patients, also in experienced PLWHIV with good virologic control

Respiratory Fungal Diseases in Adult Patients With Cystic Fibrosis

Clinical manifestations of respiratory fungal diseases in adult cystic fibrosis (CF) patients are very heterogeneous, ranging from asymptomatic colonization to chronic infections, allergic disorders, or invasive diseases in immunosuppressed CF patients after lung transplantation. In this narrative review, mainly addressed to clinicians without expertise in CF who may nonetheless encounter adult CF patients presenting with acute and chronic respiratory syndromes, we briefly summarize the most representative clinical aspects of respiratory fungal diseases in adult CF patients

Reactivation of Herpes Simplex Virus Type 1 (HSV-1) Detected on Bronchoalveolar Lavage Fluid (BALF) Samples in Critically Ill COVID-19 Patients Undergoing Invasive Mechanical Ventilation: Preliminary Results from Two Italian Centers

27noReactivation of herpes simplex virus type 1 (HSV-1) has been described in critically ill patients with coronavirus disease 2019 (COVID-19) pneumonia. In the present two-center retrospective experience, we primarily aimed to assess the cumulative risk of HSV-1 reactivation detected on bronchoalveolar fluid (BALF) samples in invasively ventilated COVID-19 patients with worsening respiratory function. The secondary objectives were the identification of predictors for HSV-1 reactivation and the assessment of its possible prognostic impact. Overall, 41 patients met the study inclusion criteria, and 12/41 patients developed HSV-1 reactivation (29%). No independent predictors of HSV-1 reactivation were identified in the present study. No association was found between HSV-1 reactivation and mortality. Eleven out of 12 patients with HSV-1 reactivation received antiviral therapy with intravenous acyclovir. In conclusion, HSV-1 reactivation is frequently detected in intubated patients with COVID-19. An antiviral treatment in COVID-19 patients with HSV-1 reactivation and worsening respiratory function might be considered.openopenGiacobbe, Daniele Roberto; Di Bella, Stefano Di; Dettori, Silvia; Brucci, Giorgia; Zerbato, Verena; Pol, Riccardo; Segat, Ludovica; D’Agaro, Pierlanfranco; Roman-Pognuz, Erik; Friso, Federica; Principe, Luigi; Lucangelo, Umberto; Ball, Lorenzo; Robba, Chiara; Battaglini, Denise; De Maria, Andrea De; Brunetti, Iole; Patroniti, Nicolò; Briano, Federica; Bruzzone, Bianca; Guarona, Giulia; Magnasco, Laura; Dentone, Chiara; Icardi, Giancarlo; Pelosi, Paolo; Luzzati, Roberto; Bassetti, MatteoGiacobbe, Daniele Roberto; Di Bella, Stefano Di; Dettori, Silvia; Brucci, Giorgia; Zerbato, Verena; Pol, Riccardo; Segat, Ludovica; D’Agaro, Pierlanfranco; Roman-Pognuz, Erik; Friso, Federica; Principe, Luigi; Lucangelo, Umberto; Ball, Lorenzo; Robba, Chiara; Battaglini, Denise; De Maria, Andrea De; Brunetti, Iole; Patroniti, Nicolò; Briano, Federica; Bruzzone, Bianca; Guarona, Giulia; Magnasco, Laura; Dentone, Chiara; Icardi, Giancarlo; Pelosi, Paolo; Luzzati, Roberto; Bassetti, Matte

Clinical presentation of secondary infectious complications in COVID-19 patients in intensive care unit treated with tocilizumab or standard of care

The hypothesis of this study is that tocilizumab should affect common signs of infection due to its immunosuppressive properties. Primary aim of the study was to investigate whether the administration of tocilizumab to critically ill patients with COVID-19, led to a different clinical presentation of infectious complications compared to patients who did not receive tocilizumab. Secondary aim was investigating differences in laboratory parameters between groups

Long-Term Effectiveness of Rilpivirine-Based Single-Tablet Regimens in a Seven-Year, Two-Center Observational Cohort of People Living with HIV

Data on the long-term durability of rilpivirine (RPV) are still scarce. A two-center retrospective study was performed, including all people living with HIV (PLWH) treated with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)/RPV or tenofovir alafenamide (TAF)/FTC/RPV in the period January 2013-December 2019. Aims of the study were to assess the rate of discontinuation of the RPV single-tablet regimen (STR) and identify factors associated with the risk of discontinuation according to Cox's regression analysis. A total of 684 PLWH were enrolled. Mean duration of RPV-STR treatment was 192.5 (+/- 99.5) weeks for 123 antiretroviral therapy (ART)-naive participants (18%) and 173.3 (+/- 85.6) weeks for 561 ART-experienced study participants (82%). During the study period, the incidence of discontinuation was 7.7 per 100 person-years. The estimated proportions of discontinuation after 48 and 96 weeks were 5.6% and 13.4%, respectively. Causes of discontinuation were loss to follow-up (30%), side effects (15%), ART optimization (14%), virological failure (VF) (12%), death or transfer to another center (9%), low adherence (7%), drug interactions (6%), simplification to dual therapy (3%), and unknown (3%). No differences were observed in cumulative probability of discontinuation between ART-naive and -experienced PLWH. Heterosexual (hazard ratio [HR] 3.0, 95% confidence interval [CI] 1.4-6.8) and mother-to-child (HR 5.3, 95% CI 1.8-15.3) transmission of HIV infection and history of previous VF (HR 1.7, 95% CI 1.2-2.5) were associated with higher risk of discontinuation. High RPV-STR effectiveness and durability were confirmed in our real-life population of PLWH. Given these data, RPV has the potential to be a drug for life in patients selected according to current guidelines

T2Bacteria and T2Resistance Assays in Critically Ill Patients with Sepsis or Septic Shock: A Descriptive Experience

The use of rapid molecular tests may anticipate the identification of causative agents and resistance determinants in the blood of critically ill patients with sepsis. From April to December 2021, all intensive care unit patients with sepsis or septic shock who were tested with the T2Bacteria and T2Resistance assays were included in a retrospective, single center study. The primary descriptive endpoints were results of rapid molecular tests and concomitant blood cultures. Overall, 38 combinations of T2Bacteria and T2Resistance tests were performed. One or more causative agent(s) were identified by the T2Bacteria assay in 26% of episodes (10/38), whereas negative and invalid results were obtained in 66% (25/38) and 8% (3/38) of episodes, respectively. The same pathogen detected by the T2Bacteria test grew from blood cultures in 30% of cases (3/10). One or more determinant(s) of resistance were identified by the T2Resistance assay in 11% of episodes (4/38). Changes in therapy based on T2Bacteria and/or T2Resistance results occurred in 21% of episodes (8/38). In conclusion, T2Bacteria/T2Resistance results can influence early treatment decisions in critically ill patients with sepsis or septic shock in real-life practice. Large, controlled studies remain necessary to confirm a favorable impact on patients’ outcomes and antimicrobial stewardship interventions

Tocilizumab and steroid treatment in patients with COVID-19 pneumonia

Coronavirus disease 2019 (COVID-19) can lead to respiratory failure due to severe immune response. Treatment targeting this immune response might be beneficial but there is limited evidence on its efficacy. The aim of this study was to determine if early treatment of patients with COVID-19 pneumonia with tocilizumab and/or steroids was associated with better outcome